Search Results (79)

Background/Objectives: Early childhood caries (ECC) is the most common chronic disease of childhood worldwide. Commercial baby food pouches have become increasingly popular because of their convenience and perceived healthfulness; however, their sugar content and characteristic feeding practices have raised concerns regarding children’s oral health. This study characterized caregiver-reported commercial baby food pouch use, feeding practices, caregiver perceptions, and caries experience while considering implications for child oral health and public health policy. Methods: A cross-sectional study was conducted among 200 caregiver–child dyads attending the UCLA Children’s Dental Center. Eligible children were aged 0–6 years and currently consumed commercial baby food pouches. Caregivers completed a structured survey assessing pouch use, feeding practices, brand preferences, and perceptions, and children underwent oral examinations to assess caries experience using the decayed, missing, and filled teeth (dmft) index. Results: One-third (34%) of children consumed at least one commercial baby food pouch daily, 32% consumed pouches several times per week, and 34% consumed them less than once per week. Pouch consumption frequency differed descriptively across age groups, with approximately one-third of children aged 0–<2 years consuming pouches daily compared with approximately 20% in each older age group. Children who consumed pouches by direct, child-controlled sucking had the highest mean dmft score (5.12), followed by caregiver-controlled sucking (4.50); however, age-stratified analyses found no statistically significant differences in dmft score distributions by feeding method, frequency of pouch consumption, or time spent sucking each pouch (all p > 0.05). Two-thirds of caregivers (66%) reported providing pouches primarily during travel or transportation, and convenience was the most frequently cited caregiver-reported advantage. No statistically significant association was observed between caregiver education and pouch use frequency (χ²(20, N = 200) = 23.72, p = 0.26). The three most commonly reported pouch brands contained total sugar levels ranging from 95% to 162% of those found in a similarly sized serving of Coca-Cola, despite the pouch products reporting 0 g of added sugars on their Nutrition Facts labels. Conclusions: Among current pouch consumers, commercial baby food pouches were frequently incorporated into feeding practices throughout early childhood. The substantial total sugar content of commonly reported pouch products, caregiver feeding practices, and common perception as healthy products highlight opportunities for anticipatory guidance, caregiver education, clearer nutrition labeling, and public health policies that support healthier feeding practices. Full article

Objectives: The objective of this study was to longitudinally evaluate mandibular condylar trabecular organization in children with a history of severe early childhood caries (SECC) and caries-free controls using fractal dimension (FD) analysis, and to compare the findings according to sex. Methods: This retrospective follow-up study included 100 children (50 with a history of SECC and 50 caries-free controls) with panoramic radiographs obtained at T0 (5 years) and T1 (8 years). FD analysis of the mandibular condyle was performed using the box-counting method on standardized regions of interest (ROIs; 21 × 21 pixels) following image calibration. Independent and paired t-tests and a linear mixed-effects model were used for statistical analysis at p < 0.05. Results: No significant difference in FD values was observed between the SECC and control groups at T0 (p > 0.05). At T1, the control group exhibited significantly higher FD values than the SECC group (1.151 ± 0.06 vs. 1.076 ± 0.10, p < 0.001). The linear mixed-effects model demonstrated a significant group × time interaction (p < 0.001), indicating different longitudinal trajectories between the groups. Within-group comparisons showed no significant longitudinal change in the SECC group (p > 0.05), whereas FD values increased significantly in the control group (p < 0.001). No significant effects of sex or related interactions were identified (p > 0.05). Conclusions: Children with a history of SECC did not exhibit the age-related longitudinal increase in mandibular condylar FD values observed in caries-free controls. These findings suggest that a history of SECC may be associated with an altered longitudinal pattern of condylar trabecular organization during growth; however, further studies are required to confirm this association. Full article

Background: Early childhood caries (ECC) is a common chronic disease in children and has been associated with systemic inflammatory and nutritional alterations. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score reflects immunonutritional status. This study investigated the associations of the HALP score and hematological parameters with ECC, caries burden, and periapical disease severity. Methods: This retrospective comparative study included 126 preschool children: 97 with ECC and 29 caries-free controls. Participants were further classified into low (Periapical Index (PAI) 1–3) and high (PAI 4–5) periapical disease severity groups according to the highest Periapical Index score. The HALP score was calculated using the standard formula. Statistical significance was set at p < 0.05. Results: No statistically significant association was detected between the HALP score and ECC, dmft, or periapical disease severity (p > 0.05). Albumin levels were higher in the ECC group than in controls (p < 0.001). Neither the HALP score nor its individual hematological components were associated with caries burden in negative binomial regression analyses (p > 0.05). Greater caries burden was independently associated with severe periapical disease (Odds Ratio (OR) = 1.19, 95% Confidence Interval (CI): 1.09–1.30, p < 0.001), whereas hemoglobin was not (p = 0.052). Conclusions: No statistically significant association was detected between the HALP score and ECC status, caries burden, or periapical disease severity. Although albumin levels differed between children with ECC and caries-free controls, neither the HALP score nor its individual hematological components were independently associated with caries burden. Larger prospective multicenter studies are needed to validate these findings. Full article

Background/Objective: Artificial intelligence (AI) is increasingly transforming healthcare and has emerged as a promising tool in pediatric dentistry. This narrative review examines the methodological foundations, current applications, limitations, and future directions of AI in pediatric dental practice. Methods: A structured literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar for relevant English-language publications from database inception through to May 2026, using predefined search terms and eligibility criteria. Following screening and full-text assessment, 72 unique publications were retained for the narrative synthesis. Results: AI applications in pediatric dentistry include early childhood caries detection and risk prediction, dental plaque assessment, identification of mesiodens and supernumerary teeth, dental age estimation, automated tooth detection, fissure-sealant evaluation, and craniofacial growth prediction. Several imaging-based models demonstrated performance comparable to experienced clinicians. However, many studies relied on retrospective, single-center datasets and lacked external or prospective validation. Additional concerns included algorithmic bias, data privacy, limited interpretability, and infrastructure requirements. Conclusions: AI has considerable potential to improve diagnostic efficiency, consistency, and personalized preventive care in pediatric dentistry. However, it should be used as a clinical decision-support tool rather than a replacement for professional judgment. Future research should prioritize prospective multicenter validation, multimodal and explainable systems, standardized reporting, and ethical clinical implementation. Full article

Background: Early childhood caries (ECC) is a biofilm-mediated and sugar-driven disease associated with local and systemic inflammatory responses. This study evaluated serum Interleukin-6 (IL-6) and IL-10 concentrations, hematologic inflammatory indices, and oral inflammatory parameters in children with ECC compared with caries-free sibling controls. Methods: This sibling-controlled case–control study included 155 children aged 2.5–6 years, comprising 120 children with active ECC and 35 caries-free siblings. Serum IL-6 and IL-10 concentrations were measured using enzyme-linked immunosorbent assay (ELISA). Complete blood count parameters and derived inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), aggregate index of systemic inflammation (AISI), cumulative inflammatory index (IIC), and mean corpuscular volume-to-lymphocyte ratio (MCVL), were calculated. Plaque Index (PI) and Gingival Index (GI) were recorded in children with ECC. Group comparisons, correlation analyses, ROC analysis, and multivariable logistic regression were performed. Results: Children with ECC exhibited significantly higher serum IL-6 and IL-10 concentrations than sibling controls. MCVL values were significantly lower in the ECC group, whereas several inflammatory indices indicated an increased systemic inflammatory burden. Stratification by PI tertiles showed progressively higher values for WBC, NEU, NLR, SII, SIRI, AISI, and IIC as plaque accumulation increased (all p < 0.05). PI was strongly correlated with GI (r = 0.811, p < 0.001) and moderately correlated with NLR (r = 0.536), SII (r = 0.536), SIRI (r = 0.654), AISI (r = 0.648), and IIC (r = 0.546) (all p < 0.01). Serum IL-6 and IL-10 were strongly correlated (r = 0.804, p < 0.001) but not with PI or GI. ROC analysis demonstrated moderate discriminatory performance for IL-6 (AUC = 0.701) and IL-10 (AUC = 0.696). Age- and sex-adjusted multivariable logistic regression demonstrated that elevated IL-6 concentrations (adjusted OR = 1.36; 95% CI, 1.10–1.68; p = 0.005) remained independently associated with ECC, whereas increasing MCVL values (adjusted OR = 0.92; 95% CI, 0.86–0.98; p = 0.010) were associated with reduced odds of ECC. Conclusions: ECC is associated with systemic cytokine alterations and increased hematologic inflammatory burden. While IL-6 and IL-10 distinguish children with ECC from sibling controls, plaque accumulation severity is better reflected by composite hematologic inflammatory indices than by isolated cytokine concentrations. IL-6 and MCVL may be promising adjunctive biomarkers for ECC. Full article

Recurrence remains a significant challenge following the treatment of Severe Early Childhood Caries (S-ECC). This study aimed to identify candidate recurrence-related biomarkers for S-ECC and elucidate their potential pathogenic mechanisms. Through metagenomic sequencing of supragingival plaque from 32 children at one month post-treatment, we identified Leptotrichia hofstadii as one of the potential biomarkers for S-ECC recurrence (AUC = 0.8438 for the sequencing set and AUC = 0.75 for the validation set). In vitro dual-species biofilm assays using crystal violet staining and Confocal Laser Scanning Microscopy (CLSM) demonstrated that L. hofstadii promotes early-stage S. mutans colonization and extracellular polysaccharide (EPS) formation through contact-dependent synergistic interactions. Scanning electron microscopy revealed that L. hofstadii may function as a spatial scaffold within dual-species biofilm. Furthermore, this synergy significantly accelerates environmental acidification, leading to earlier attainment of the critical demineralization threshold (pH 5.5). At the transcriptional level, carbohydrate metabolism-related pathways were upregulated in dual-species biofilm, including starch and sucrose metabolism, PTS and ABC transporters. Additionally, the fruA gene, which degrades fructan in EPS was downregulated in the dual-species biofilm compared with S. mutans monoculture. These findings suggest that L. hofstadii facilitates a cariogenic microenvironment by enhancing the metabolic activity of S. mutans biofilms. Collectively, this study identifies L. hofstadii as a potential biomarker for S-ECC recurrence prediction and provides preliminary insights into possible interspecies mechanisms, offering valuable clues for future research into targeted preventive strategies. Full article

Purpose: To provide an evidence-calibrated, time-bound clinical framework for using 38% silver diamine fluoride (SDF) as interim stabilization for severe early childhood caries (SECC) in young children, addressing gaps in existing guidelines regarding treatment duration, exit criteria, equity, and system accountability. Methods: This framework was developed from the American Academy of Pediatric Dentistry (AAPD) guidance (2017–2025), the 2024 Cochrane review, real-world utilization studies, and a narrative review proposing a preservation-to-precision heuristic. Recommendations are expressed using GRADE terminology. Results: The framework includes ten recommendations, a systems drift principle, explicit time thresholds (<6 months, 6–12 months, >12 months), a 12-month reassessment mandate, equity guardrails, a bridge vs. destination consent model, and a future research agenda. A clinical vignette contrasts appropriate short-term bridging with prolonged temporization due to access barriers. Conclusions: SDF is conditionally recommended for caries arrest in primary teeth. In children with SECC, SDF should be used within a documented, time-bound preservation-to-precision pathway. SDF should not become an open-ended substitute for definitive restorative care. Explicit equity implementation prevents the framework from penalizing underserved children. Full article

Objectives: To systematically review the evidence on the association between early childhood caries (ECC) and oral health-related quality of life (OHRQoL) in preschool children, focusing on studies using the Early Childhood Oral Health Impact Scale (ECOHIS) or its validated language versions. Methods: This systematic review was conducted and reported in accordance with the PRISMA 2020 guidelines. Electronic searches identified primary observational studies published within the last 10 years. Eligible studies included preschool children, clinically assessed ECC/caries, and OHRQoL measured with ECOHIS or a validated, adapted version. Data extraction covered study characteristics, caries assessment, OHRQoL measures, and main findings. Risk of bias was assessed using the Joanna Briggs Institute appraisal tools. Results: Twenty studies were included (19 cross-sectional and 1 cohort) with sample sizes ranging from 151 to 1783 participants. Across diverse populations and settings, ECC was consistently associated with poorer OHRQoL in preschool children and their families. Greater caries severity, untreated lesions, and advanced disease consequences were generally linked to higher ECOHIS scores. The most affected domains were pain, eating and drinking difficulties, sleep disturbance, irritability, and family distress. Conclusions: The available evidence consistently indicates that ECC is associated with poorer OHRQoL in preschool children and their families. From a clinical perspective, incorporating OHRQoL measures into pediatric dental assessment may improve recognition of disease burden beyond clinical indices alone. Full article

Background/Objectives: Early childhood caries (ECC) is a chronic inflammatory condition that may impose a systemic burden in pediatric patients. This study aimed to evaluate the association between dental caries severity, classified by dmft (decayed, missing, and filled teeth for primary dentition) scores, and preoperative systemic inflammatory markers derived from routine complete blood counts (CBC). Methods: This retrospective study included 159 children aged 36–71 months. Participants were categorized into three groups based on dmft scores: low (0–3), medium (4–8), and high (≥9). Hematological parameters and inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII), were analyzed using one-way ANOVA with post hoc comparisons. Results: Significant differences were observed among dmft groups for neutrophil and lymphocyte percentages (p = 0.026 and p = 0.027) and lymphocyte count (p = 0.020). The medium severity group demonstrated higher neutrophil levels and lower lymphocyte values compared to the high severity group (p < 0.05). Although overall group differences for NLR and SII were not statistically significant (p > 0.05), both markers were significantly higher in the medium group than in the high group (p < 0.05). No significant differences were found in hemoglobin, RDW, or platelet parameters. Conclusions: A non-linear trend was observed, with relatively elevated inflammatory markers in the moderate dmft group. These findings suggest that systemic inflammation in ECC is more closely related to disease characteristics than to caries burden alone. CBC-derived parameters may provide supportive but limited value for assessing systemic inflammatory status in pediatric dental patients. Full article

Severe early childhood caries (SECC) in preschool children is a progressive, multifactorial disease with far-reaching consequences for child health, family functioning, and health systems. Minimally invasive dentistry (MID), particularly 38% silver diamine fluoride (SDF), is increasingly used to arrest lesions and “buy time” when definitive restorative care is delayed. This narrative review synthesizes current evidence-based guidelines and real-world utilization data to clarify the appropriate role and limits of SDF in SECC management. Professional guidance supports SDF for lesion arrest within an ongoing caries management plan, but does not endorse it as a universal long-term substitute for durable restorative care. Observational studies show that many SDF-treated primary teeth receive additional intervention within approximately 2 years, and any delay in sedation/general anesthesia is typically measured in weeks to months. A large recent private practice study found that 35% of children with caries progressed to higher-intensity treatment (restoration or extraction) over a median of 547 days, reinforcing the time-limited nature of interim stabilization. We propose a “preservation-to-precision” framework that prioritizes child-centered outcomes—freedom from pain and infection, durable function, and acceptable psychosocial impact—through risk-based, tooth- and child-specific planning, realistic follow-up assessment, and clear exit criteria for transition to definitive care. In high-income settings, the ethical value of “buying time” depends on whether systems use that time to advance children toward timely, definitive care rather than normalizing prolonged temporization as routine practice. Full article

Early childhood caries (SECC) in children aged 3–4 years is a high-burden condition with consequences that extend beyond the dentition, including pain, infection, sleep disturbance, impaired nutrition, disrupted family functioning, and diminished quality of life. In contemporary pediatric practice, 38% silver diamine fluoride (SDF) and other minimally invasive approaches are widely used to stabilize disease while behavior matures, preventive strategies are intensified, or access to definitive care is secured. This perspective argues that SDF should be conceptualized not as a standalone solution, but as an evidence-supported interim stabilization strategy embedded within a defined, goal-directed care pathway. Its use is most appropriate when framed as a means of buying time under clear clinical intent, particularly in cases where teeth are expected to remain functional for years, symptoms are present, structural integrity is compromised, or follow up is uncertain. Although clinical guidelines and systematic reviews support SDF for arresting cavitated lesions in primary teeth, current evidence does not support its use as a universal long-term treatment for severe disease. Real-world data suggest that many SDF-treated teeth require additional intervention within approximately 2 years, and that delays to definitive care—including treatment under sedation or general anesthesia when indicated—are often relatively short. In response, this paper proposes a practical bridge-to-destination framework grounded in three principles: explicit treatment intent, child-centered outcomes, and predefined exit criteria to ensure a timely transition to definitive dental care. Rather than discouraging SDF use, this approach seeks to optimize its role within a continuum of dental care, emphasizing proportionality, transparency, and durable outcomes for children. Full article

Background: Early Childhood Caries (ECC) is a prevalent multifactorial disease strongly influenced by dietary and behavioral factors. Night-time feeding practices and sugar exposure have been implicated, yet the relative impact of feeding duration, feeding type, and oral hygiene remains debated. This study aimed to investigate the association between ECC and major dietary and behavioral risk factors, with particular emphasis on the presence and duration of night-time feeding, in a pediatric population from Southern Italy. Methods: A single-center retrospective observational study was conducted on medical records of children aged 1–6 years referred for a first dental visit to a pediatric dentistry unit. ECC and severe ECC (S-ECC) were diagnosed according to AAPD criteria. Data on night-time feeding (presence and duration), sugar-rich diet, number of daily meals, oral hygiene habits, and age at initiation of toothbrushing were collected through structured interviews. Associations were evaluated using chi-square tests and multivariable logistic regression analysis, with ECC/S-ECC as the dependent variable. Results: A total of 248 children were included. ECC/S-ECC prevalence was 62.5%. A sugar-rich diet was associated with increased ECC risk (OR = 4.14, p < 0.001). Prolonged night-time feeding showed a dose–response relationship with ECC, with risk increasing beyond 12 months and exceeding twelvefold for durations > 24 months. Multivariable analysis showed that night-time feeding duration > 12 months, high-sugar diet, >5 daily meals, and delayed initiation of toothbrushing were associated with ECC, whereas use of an electric toothbrush and fluoridated toothpaste showed a trend toward a protective effect. Feeding type was not independently associated with ECC after adjustment for duration. Conclusions: Duration of night-time feeding, rather than feeding type, represents a key modifiable determinant of ECC risk. Preventive strategies should prioritize early cessation of night-time feeding, reduction in sugar exposure, limitation of meal frequency, and early introduction of effective oral hygiene with fluoride. Full article

Background: General anesthesia (GA) plays a key role in pediatric dentistry by enabling comprehensive dental treatment in children who cannot be adequately managed using conventional behavioral techniques, local anesthesia, or sedation. While previous reviews have primarily focused on safety outcomes and adverse events, less attention has been given to patterns of GA utilization and their broader clinical and public health implications. Objective: The objective was to synthesize and critically analyze contemporary evidence on utilization patterns, clinical indications, and treatment characteristics associated with GA in pediatric dentistry and to interpret variability in GA use as a clinical and health-system indicator. Methods: A systematic review with qualitative synthesis was conducted in accordance with PRISMA 2020 guidelines. Electronic searches were performed in EBSCOhost, Scopus, and the Cochrane Library to identify observational studies published between 2015 and 2025 reporting clinical data on pediatric dental treatment under GA. Results: Twenty-two observational studies met the inclusion criteria. Severe early childhood caries was the most frequently reported indication for GA, followed by behavioral management difficulties and treatment of children with special health care needs. Reported utilization rates varied widely across healthcare systems. Conclusions: GA remains an essential modality for managing complex pediatric dental cases; however, variability in utilization appears to reflect differences in preventive access, disease burden, and health-system organization. Interpreting GA use as a healthcare utilization indicator may support improved preventive strategies and policies aimed at reducing repeated GA exposure in vulnerable pediatric populations. Full article

While breastfeeding is strongly recommended for infant health, uncertainty remains regarding its independent association with early childhood caries after accounting for sugar exposure. Objective: This study aimed to evaluate the controlled direct effect of breastfeeding on dental caries. Methods: Data were drawn from two population-based birth cohort studies: the 2015 Pelotas Birth Cohort Study (Brazil) and the SMILE Study (Australia). The exposure was any breastfeeding at 3, 6, and 12 months, with sugar consumption at 12 and 24 months as the mediator. The outcome was dental caries at ages 4/5, assessed as early childhood caries (ECC), severe ECC, any disease experience, or any decayed teeth. Marginal Structural Models with inverse probability of treatment weight were used to estimate the controlled direct effect of breastfeeding on dental caries, accounting for sociodemographic confounders and sugar consumption. Results: A total of 751 Australian and 3545 Brazilian children were included in at least one sub-analysis. Findings indicate a contextual difference: in Australia, breastfeeding had no effect on dental caries after considering sugar consumption as mediator, whereas in Brazil, children not breastfed had a lower risk of dental caries. For instance, adjusted Brazilian estimates showed a reduced relative risk ranging from 0.63 (95% CI 0.55; 0.72) for ECC to 0.43 (95% CI 0.34; 0.55) for severe ECC. Conclusions: The association between breastfeeding and dental caries appears to vary across socio-environmental contexts. In settings with high caries burden, prolonged breastfeeding may increase caries risk independently of sugar consumption; however, breastfeeding remains strongly recommended given its substantial overall health benefits. These findings highlight the importance of integrating early oral health guidance such as oral health education into breastfeeding support programs. Full article

Objectives: This study aimed to characterize the age-related trends of caries experience among preschool children in Shenzhen, China. Methods: This cross-sectional study recruited 3- to 5-year-old preschool children in Shenzhen via a multistage random sampling method in 2024. Two calibrated examiners conducted oral examinations in kindergartens using disposable dental mirrors with LED illumination and ball-ended Community Periodontal Index probes. Caries experience was recorded using the dmft index, as recommended by the World Health Organization. Results: This study invited 4015 children from 27 selected kindergartens, and 3534 children (1886 boys, 53%) completed the survey. The response rate was 88%. The prevalence of caries experience was 31% at age 3, 49% at age 4, and 58% at age 5, representing a 27% higher prevalence in 5-year-olds than in 3-year-olds. The mean dmft scores (±SD) were 1.2 ± 2.5 for 3-year-olds, 2.2 ± 3.2 for 4-year-olds, and 2.8 ± 3.5 for 5-year-olds, indicating a 1.6 affected teeth higher mean dmft in 5-year-olds than in 3-year-olds. The upper central incisors were the most affected teeth (23%) in 3-year-olds and remained the most susceptible across all age groups, while the prevalence of caries in lower molars increased progressively from 7% at age 3 to 24% at age 5. Conclusions: Dental caries prevalence and severity among preschool children in Shenzhen increase significantly with age. These findings highlight the need for targeted preventive strategies focusing on high-risk teeth, including the upper central incisors and lower molars, to address the rising burden of early childhood caries in this population. Full article